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E. coli Blog

Surveillance & Analysis on E. coli News & Outbreaks

Flour E. coli Outbreak Update

recalled-General-Mills-flour-406x250As of June 28, 2016, 42 people infected with the outbreak strain of STEC O121 have been reported from 21 states – Alabama 1, Arkansas 1, Arizona 2, California 2 (up 1), Colorado 4, Iowa 1, Illinois, 4, Indiana 1 (New), Massachusetts 2, Maryland 1, Michigan 4, Minnesota 3, Missouri 1, Montana 2 (up 1), New York 1, Oklahoma 2, Pennsylvania 2, Texas 2, Virginia 2, Washington 3 (up 1), and Wisconsin 1.

Illnesses started on dates ranging from December 21, 2015 to June 8, 2016. Ill people range in age from 1 year to 95, with a median age of 18. Eighty-one percent of ill people are female. Eleven ill people have been hospitalized. No one has developed hemolytic uremic syndrome, a type of kidney failure, and no deaths have been reported.

In June 2016, laboratory testing by the U.S. Food and Drug Administration (FDA) isolated STEC O121 from samples of General Mills flour collected from the home of an ill person in Oklahoma. The STEC O121 isolated from the flour sample has the same PFGE pattern, or DNA fingerprint, as the outbreak strain. The flour collected in Oklahoma was not included in the initial General Mills recall.

In the same month, FDA identified STEC O121 in an open sample of General Mills flour collected from the homes of ill people in Colorado and Arizona. Whole genome sequencing (WGS) showed that the STEC O121 isolates from the flour samples were closely related genetically to the STEC O121 isolates from ill people. The flour sample that was tested came from lots of flour included in the initial recall announced by General Mills.

On July 1, 2016, General Mills expanded the recall to include some flours sold under the same brand names included in the initial recall: Gold Medal Flour, Gold Medal Wondra Flour, and Signature Kitchens Flour. CDC recommends that consumers, restaurants, and retailers do not use, serve, or sell the recalled flours.

Chicago Live Fire E. coli Outbreak

Carbon-thumb-640xauto-954656The Chicago Department of Public Health (CDPH) has identified an outbreak of Shiga toxin-producing E. coli (STEC), impacting at least 25 Chicago residents. As part of the CDPH investigation, Carbón Live Fire Mexican Grill located at 300 W. 26th Street has been linked to the outbreak. Following a request from CDPH, Carbón closed voluntarily and is fully cooperating with the investigation. At least 5 individuals have been hospitalized as part of this outbreak. One of the leading symptoms caused by STEC is diarrhea, including bloody diarrhea. Infection can also lead to more serious complications.

CDPH recommends anyone who recently ate at the restaurant in question and is suffering these symptoms to see a medical provider for testing and inform them of the possibility of STEC.

“This is a serious condition that is treatable,” said CDPH Commissioner Julie Morita, M.D. “Anyone who believes they may be symptomatic and ate at this restaurant should see their medical provider immediately. CDPH is taking every precaution as part of our robust response in order to limit the impact of this outbreak.”

STEC can be transmitted through consumption of contaminated foods including undercooked beef, unpasteurized juice, raw milk and unwashed, raw produce. The menu items responsible for this outbreak have not yet been identified and the investigation is ongoing. Health officials continue to be onsite at the 300 W. 26th Street location and are also interviewing patients to rule out other possible exposures.

CDPH has also issued an alert to area physicians of the outbreak, providing medical guidance. Medical providers who suspect STEC should submit specimens for testing. Antibiotics and anti-diarrheal medicines should not be used to treat STEC as they may worsen symptoms. Medical experts instead encourage supportive medical care, including intravenous fluids, where necessary. Chicago providers must report diagnosed cases to the Chicago Department of Public Health.

E. coli Outbreak at Pho 75 Vietnamese Restaurant

Colorado press reports that the Colorado Department of Public Health and Environment are investigating an outbreak of E. coli O157:H7 in Aurora. The outbreak was reported at Pho 75, an Aurora restaurant located at 2050 South Havana Street.

So far, four ill people have been identified, but as with any outbreak, it is possible that there are more sick than reported, as some might not go to the doctor. One of the four ill was hospitalized.

The Tri-County Health Department is working with the restaurant during the investigation. Pho 75 voluntarily closed yesterday. According to the state, typically when a restaurant closes in this kind of situation, a list of requirements must be met before they are allowed to reopen.

Flour Linked to Another E. coli Outbreak

General Mills Inc. has initiated a nationwide recall of three brands of flour, totaling about 10 million pounds, in response to a 20-state E. coli outbreak that has sickened 38 people.

Although government officials have reportedly been investigating the outbreak, no state or federal agencies had released any information about it at the point Tuesday when the Minneapolis-based company announced the recall.

These are three of several varieties and brands of flour recalled by General Mills in relation to a multi-state outbreak of E. coli.

“State and federal authorities have been researching 38 occurrences of illnesses across 20 states related to a specific type of E. coli O121, between Dec.21, 2015, and May 3, 2016,” according to a news release from General Mills.

“While attempting to track the cause of the illness, CDC (Centers for Disease Control and Prevention) found that approximately half of the individuals reported making something homemade with flour at some point prior to becoming ill. Some reported using a General Mills brand of flour.”

The recall includes six SKUs (stock keeping units or UPC codes) of Gold Medal branded flour, two SKU’s of Signature Kitchens branded flour and one SKU of Gold Medal Wondra branded flour.

Retailers that received shipments of the recalled flour include Safeway, Albertsons, Jewel, Shaws, Vons, United, Randalls, and Acme.

“To date, E. coli O121 has not been found in any General Mills flour products or in the flour manufacturing facility, and the company has not been contacted directly by any consumer reporting confirmed illnesses related to these products,” according to the news release.

“As a leading provider of flour for 150 years, we felt it was important to not only recall the product and replace it for consumers if there was any doubt, but also to take this opportunity to remind our consumers how to safely handle flour,” Liz Nordlie, president of General Mills Baking division, said in the release.

Some of the outbreak victims may have eaten raw dough or batter. Nordlie said in the news release and a separate blog posting that no one, especially young children, should ever eat raw dough or batter because of potential pathogens.

“Consumers are reminded to not consume any raw products made with flour. Flour is an ingredient that comes from milling wheat, something grown outdoors that carries with it risks of bacteria which are rendered harmless by baking, frying or boiling,” according to the news release.

“Consumers are reminded to wash their hands, work surfaces, and utensils thoroughly after contact with raw dough products or flour, and to never eat raw dough or batter.”

The recalled flour can be identified by the following label information:

  • 5-ounce Gold Medal Wondra — Package UPC 000-16000-18980; Better if Used by Dates 25FEB2017 thru 30MAR2017
  • 2-pound Gold Medal All Purpose Flour — Package UPC 000-16000-10710; Better if Used by Dates 25MAY2017KC thru 03JUN2017K
  • 5-pound Gold Medal All Purpose Flour — Package UPC 000-16000-10610; Better if Used by Dates 25MAY2017KC, 27MAY2017KC thru 31MAY2017KC, 01JUN2017KC, 03JUN2017KC thru 05JUN2017KC, 11JUN2017KC thru 14JUN2017KC
  • 10-pound Gold Medal All Purpose Flour — Package UPC 000-16000-10410; Better if Used by Dates 02JUN2017KC,03JUN2017KC
  • 10-pound Gold Medal All Purpose Flour Banded Pack — Package UPC 000-16000-10410; Better if Used by Dates 03JUN2017KC, 04JUN2017KC, 05JUN2017KC
  • 5-pound Gold Medal Unbleached Flour — Package UPC 000-16000-19610; Better if Used by Dates 25MAY2017KC, 27MAY2017KC, 03JUN2017KC, 04JUN2017KC
  • 5-pound Signature Kitchens All Purpose Flour Enriched Bleached — Package UPC 000-21130-53001; Better if Used by Dates BB MAY 28 2017
  • 5-pound Signature Kitchens Unbleached Flour All Purpose Enriched —Package UPC 000-21130-53022; Better if Used by Dates BB MAY 27 2017
  • 2-pound Gold Medal Self Rising Flour — Package UPC 000-16000-11710; Better if Used by Dates 23AUG2016KC

Pizza Ranch desserts containing flour dough have been linked to E. coli O157:H7 food poisonings in nine states, federal officials say. The outbreak started in December, mainly among people who’d eaten at the Iowa-based chain’s restaurants.  The CDC reports that 13 people were sickened in Illinois, Iowa, Kansas, Minnesota, North Carolina, Nebraska, New Jersey, South Dakota and Wisconsin. Minnesota. Nine of the people said they recently had eaten at Pizza Ranches.  Two children, in Kansas and Nebraska, suffered kidney failure (hemolytic uremic syndrome) and had to be hospitalized.

In an article in Clinical Infections Diseases dug a bit deeper into the Nestle Tollhouse Cookie Dough E. coli O157:H7 outbreak of 2009.  Seventy-seven patients with illnesses during the period 16 March–8 July 2009 were identified from 30 states; 35 were hospitalized, 10 developed hemolytic-uremic syndrome, and none died. Sixty-six percent of patients were <19 years; 71% were female. In the case-control study, 33 of 35 case patients (94%) consumed ready-to-bake commercial prepackaged cookie dough, compared with 4 of 36 controls (11%) (matched odds ratio = 41.3; P < .001); no other reported exposures were significantly associated with illness. Among case patients consuming cookie dough, 94% reported brand A. Three nonoutbreak STEC strains were isolated from brand A cookie dough. The investigation led to a recall of 3.6 million packages of brand A cookie dough and a product reformulation.

A more likely source of contamination is that a contaminated ingredient was used in the product. Ready-to-bake cookie dough is not a ready-to-eat food and contains several ingredients, including flour, pasteurized eggs, chocolate chips, molasses, sugar, margarine, baking soda, and vanillin/vanilla extract. The eggs used in brand A products were pasteurized, making eggs a less likely vehicle unless there was a pasteurization failure; this was not identified during the investigation. Molasses, sugar, baking soda, and margarine, which undergo pathogen kill steps during processing, were also considered less likely sources of contamination.

The possibility of contaminated chocolate chips was considered, because most patients reported consuming chocolate chip–containing varieties of brand A cookie dough. Although chocolate has never been linked to past E. coli O157 outbreaks, it has been implicated in Salmonella outbreaks, and Baylis et al, documented survival of E. coli O157 in artificially contaminated chocolate for up to 366 days. However, because chocolate chip varieties comprise the majority of cookie dough sales, it would not be unusual that chocolate chip varieties were reported by most patients. The chocolate chips that company A uses in its ready-to-bake cookie dough and the brand A chocolate chips sold to consumers for home baking are manufactured in the same facility, but there was no evidence of an E. coli O157 outbreak among consumers using these chocolate chips. Study results also support that chocolate chips were not the source of contamination: consumption of a chocolate chip variety of cookie dough was less strongly associated with illness compared with consumption of any cookie dough, whereas consumption of chocolate chips in non–cookie dough products was not significantly associated with illness. Flour, a raw agricultural product (ie, does not undergo processing to kill pathogens), was also considered as a possible source of contamination. Low levels of Salmonella contamination can occur in wheat flour, and flour and flour-based mixes have been implicated in foodborne Salmonella outbreaks. Generic E. coli species have also been found in flour; 1 US study found E. coli in 12.8% of commercial wheat flour samples examined. Although our investigation found no conclusive evidence that contaminated flour was the source of this outbreak, contaminated flour remains a prime suspect for introducing the pathogen to the product. Because flour is frequently purchased in large quantities by manufacturers for use in food products, if contaminated flour were responsible, a single purchase of contaminated flour might have been used to manufacture multiple lots and varieties of dough over a period of time. This would be consistent with UBDs on packages obtained from patients (23 June–11 August 2009), suggesting that product contamination occurred over several weeks.

Now 34 with E. coli Linked to Oak Leaf Farm

The State Department of Public Health (DPH) today issued the following update on the E. coli outbreak linked to the Oak Leaf Farm in Lebanon, CT:

DPH is investigating 34 confirmed cases of E. coli O157 infection linked to the farm.  The patients range in age from 10 months to 45 years, with a median age of five years.  The patients include six adults and 28 children 14 years old and under; 18 of the children are age five years or under.  In total, nine patients have been hospitalized with four still in the hospital.  Three of the hospitalized patients have been diagnosed with hemolytic uremic syndrome (HUS), a rare but serious illness that affects the kidneys and blood clotting system.

DPH is aware of three patients who did not visit Oak Leaf Farm but became ill with E. coli after having contact with someone with an E. coli infection who did visit the farm. These people are referred to as secondary cases. DPH continues to monitor for additional reports of secondary cases.

At least 15 with E. coli tied to Oak Leaf Farm

The Connecticut State Department of Public Health (DPH) today issued the following update on the E. coli outbreak linked to the Oak Leaf Farm in Lebanon, CT:

As of 1:00 p.m. today, DPH is investigating 15 confirmed cases of E. coli O157 infection.  The number of cases could increase in the near future as DPH is actively identifying individuals who were not initially reported.

So far, investigators have been able to link 14 of these cases to Oak Leaf Farm.  The patients range in age from 1-44 years old, with a median age of six.  In total, five patients have been hospitalized with three still in the hospital.  Two of the hospitalized patients have been diagnosed with Hemolytic Uremic Syndrome (HUS), as first reported last week.

Yesterday, the Centers for Disease Control and Prevention (CDC) dispatched a team to Connecticut to assist in the investigation of this outbreak.  Today, officials from DPH, the Connecticut Department of Agriculture, the Uncas Health District, and the CDC team are at the Oak Leaf Farm conducting an onsite investigation.  The Farm remains voluntarily closed to the public, and the owners are cooperating with the investigation.

The outbreak was first identified on Thursday, March 24th when six of seven individuals sickened with E. coli were confirmed by DPH to have recently visited Oak Leaf Farm and come into contact with goats on the farm.  Two of the seven initial patients had subsequently developed Hemolytic Uremic Syndrome (HUS), a rare but serious illness that affects the kidneys and blood clotting system. As of today, both of those patients continue to be hospitalized.

Unclear at this point if people should have been reading www.fair-safety.com or www.realrawmilkfacts.com – or both.

Pizza Ranch E. coli Outbreak in Illinois, Iowa, Kansas, Minnesota, North Carolina, Nebraska, New Jersey, South Dakota and Wisconsin

10298684_10152794480259144_870828925358065408_n.0.0Pizza Ranch desserts have been linked to E. coli O157:H7 food poisonings in nine states.

The outbreak started in December, mainly among people who had eaten at the Iowa-based chain’s restaurants.  The CDC reports that 13 people were sickened in Illinois, Iowa, Kansas, Minnesota, North Carolina, Nebraska, New Jersey, South Dakota and Wisconsin . Nine of the people said they recently had eaten at Pizza Ranches.  Two children, in Kansas and Nebraska, suffered kidney failure (hemolytic uremic syndrome – HUS) and had to be hospitalized.

The investigation has focused on a dry dough mix used to make desserts.

Jack & The Green Sprouts in Minnesota and Wisconsin Tied to E. coli Sproutbreak

Sprouts are a known source of foodborne illness. Children, the elderly, pregnant women and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish and mung bean sprouts). You can reduce your risk of illness by requesting that raw sprouts not be added to your food.

Symptoms of illness caused by E. coli O157 typically include stomach cramps and diarrhea, often with bloody stools, but only a low-grade or no fever. People typically become ill two to five days after exposure, but this period can range from one to eight days. Most people recover in five to 10 days. However, E. coli O157 infections sometimes lead to a serious complication called hemolytic uremic syndrome (HUS), which can cause kidney failure and other severe problems, including death. Those most at risk of developing complications from E. coli O157 include children younger than 10, the elderly, and those with weakened immune systems.

Minnesota and Wisconsin state health and agriculture officials are investigating an outbreak of foodborne illness associated with alfalfa sprouts produced by Jack & The Green Sprouts. Retailers and restaurants should not sell or serve alfalfa sprouts produced by Jack & The Green Sprouts, and consumers should not eat them at this time.

Routine disease monitoring by the Minnesota Department of Health (MDH) identified seven E. coli O157:NM cases in January and early February; E. coli bacteria from those cases all had the same DNA fingerprint. The ill individuals range in age from 18 to 84 years, and five are female. Four of the cases are residents of the Twin Cities metro area, and three live in greater Minnesota. Two were hospitalized, and both have recovered. Two additional cases of E. coli O157 infection, considered part of this outbreak, were identified by the Wisconsin Department of Health Services (WDHS) in Wisconsin residents. Neither case was hospitalized.

Minnesota officials are working with investigators at the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), WDHS, and the Wisconsin Department of Agriculture, Trade and Consumer Protection (WIDATCP). Jack & The Green Sprouts is located in River Falls, Wis., and distributes alfalfa sprouts to states in the upper Midwest and possibly other states. The seven Minnesota cases and at least one of the Wisconsin cases were exposed to implicated alfalfa sprouts from a variety of locations, including grocery/cooperative stores, restaurants, salad bars and commercial food service.

Chipotle E. coli Outbreaks Sickens 60 in 14 States

The initial, larger STEC O26 outbreak was first detected by public health officials in Washington and Oregon through local foodborne disease surveillance. In late October 2015, officials in those states detected an increase in illness and after interviewing ill people, they determined that illness was likely linked to eating at multiple Chipotle Mexican Grill locations.

A total of 55 people infected with the outbreak strain of STEC O26 were reported from 11 states. The majority of illnesses were reported from Washington and Oregon during October 2015. The number of ill people reported from each state was as follows: California (3), Delaware (1), Illinois (1), Kentucky (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27).

Among people for whom information was available, illnesses started on dates ranging from October 19, 2015 to December 1, 2015. Ill people ranged in age from 1 year to 94, with a median age of 21. Fifty-seven percent of ill people were female. Twenty-one (38%) people reported being hospitalized.

In December 2015, a second outbreak of a different, rare strain of STEC O26 was identified. A total of five people infected with this strain of STEC O26 were reported from three states. The number of ill people reported from each state was as follows: Kansas (1), North Dakota (1), and Oklahoma (3).

Among people for whom information was available, illnesses started on dates ranging from November 18, 2015 to November 26, 2015. Ill people ranged in age from 6 years to 25, with a median age of 22. Eighty percent of ill people were female. One (20%) person reported being hospitalized.

The epidemiologic evidence collected during these investigations suggested that a common meal item or ingredient served at Chipotle Mexican Grill restaurants was a likely source of both outbreaks. The investigations did not identify a specific food or ingredient linked to illness in either outbreak.

FSIS Reports Tennessee E.coli Illnesse linked to Ground Beef

Snapp’s Ferry Packing Company, an Afton, Tenn. establishment, is recalling approximately 410 pounds of beef product that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ground beef item was produced on Nov. 20, 2015. The following product is subject to recall:

5-lb. packages of “Ground Beef,” with a packaging date of Nov. 20, 2015.

The product subject to recall bears establishment number “Est. 9085” inside the USDA mark of inspection. The item was distributed to restaurants in the Knoxville, Tenn. area. None of this product was sold at retail.

The problem was discovered on Jan. 19, 2016, when a positive result for E. coli O157:H7 from FSIS testing was traced back to the establishment as a result of an ongoing illness investigation in Tennessee. FSIS is continuing to work with our public health partners at the Tennessee Department of Health and Knox County Health Department on this investigation and will provide updated information as it becomes available.

E. coli O157:H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.